Access Management JournalA Journal of the National Association of Healthcare Access Management Volume 33, Number 1

Developing a Career Ladder in Patient Access

Maternity Access, Then and Now

A Standardized Health Identification Card on the Horizon

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Access Management Journal Author Guidelines

The NAHAM Access Management Journal is published by the National Association for Healthcare Access Management (NAHAM). It is designed to share ideas and experiences, and to report the trends and developments in the field of access management. The Journal welcomes news, articles and story ideas from members, association bodies and other writers.

Article TopicsThe NAHAM Access Management Journal accepts unsolicited articles, but does not guarantee publication of all submissions.The Journal accepts a variety of article types, including:

• First-hand experience with trends in the field• New projects that your organization is developing or

implementing • New products or services that have increased your job

productivity • News from committee or affiliate meetings• Trends or problems emerging in the workplace or the field

in general • Reports on legislation or policy issues that affect the field• The “lighter side” of the workplace• Book reviews related to work or the field• Articles on topics of special relevance to front-line staff

The NAHAM Access Management Journal welcomes submissions from the industry. However, specific products or companies cannot be endorsed in editorial pieces and therefore should not be mentioned in the body of the article. Company and/or product information, however, may be included in a brief description contained in the author bio at the end of the article.

Submission FormatArticles should be submitted in English, by e-mail in aMicrosoft Word file. If e-mail is not available, files can besent on a CD via mail. Times New Roman 12 pt. or Arial10 pt. font is preferred. Articles should be accompanied by acover sheet that includes the article title, author(s) name(s), address, telephone number, e-mail address, and brief

biography (one to two sentences that contain the author’s name, credentials, current position and committee name and/or chapter affiliation, if applicable).

Quotes and statements from sources must be attributed. Facts (such as statistics) must be referenced. Do not useabbreviations. Acronyms may be used after the first full reference.

Photos or graphics must be camera ready and can be submitted as an attachment via e-mail along with the article.Acceptable photograph file formats are .jpg, .tiff, .gif andPDF. Photos must be high resolution (300 dpi). Hard copyphotographs also can be mailed. Graphs, tables and charts also may be submitted to further illustrate the article.

Copy EditingAllarticlesaresubjecttoeditingbytheeditorialstaff.

ExclusivityArticles should not be under consideration for publication by other periodicals, nor should they have been published previously (except as part of a presentation at a meeting).

CopyrightAuthors must agree to a copyright release, transferring copyright ownership to the Access Management Journal before an article is published.

Publication Schedule

How to SubmitAll articles and accompanying photos or graphics should be submitted via e-mail to ShauneLaMarca atslamarca@smithbucklin.com. Additional information also can be found on the NAHAM Web site at www.naham.org. Microsoft Word files on CD-Rom, hard copy photographs orsupporting materials can be mailed to:

NAHAMAttn: Access Management Journal2025 M Street, NW, Suite 800Washington, DC 20036

If you would like your photos or files returned, pleaseinclude a self-addressed, stamped envelope.

Alternatively, articles may be submitted via our secure online form, which can be found at www.naham.org. Beforecompleting the online form, please have an electronic copy (.doc or .txt file preferred) of the article ready for upload. Any accompanying attachments must be sent viae-mail to slamarca@smithbucklin.com.

Issue Materials Deadline Publication Date

Issue 1, 2009 (Printed Issue) January 22, 2009 March 26, 2009Issue2,2009(OnlineIssue) April24,2009 June22,2009Issue3,2009(OnlineIssue) July31,2009 September28,2009Issue4,2009(OnlineIssue) October10,2009 December7,2009

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Access Management Journal

Table of ContentsFeature Articles

5 Developing a Career Ladder in Patient Access By Craig Pergrem

8 Maternity Access, Then and NowBy Susan Franklin

10 Hiring Tips for Building a Successful Team By Morag J. Slchak

12 IRS Form 990, Schedule H Provides Unique Opportunities to Non-Profits By Marty Callahan

15 A Standardized Health Identification Card on the Horizon By Jim Hicks

17 Going “Green” in the Admissions Department By Kathleen Trotter

Departments

4 Editor’s Letter

19 NAHAM Advocacy Update

20 NAHAM Member Spotlight: Charlene Cathcart

23 CHAA Corner: Creating a Trusting Environment in Your Workplace

26 Book Review: “Now, Discover Your Strengths”

A Journal of the National Association of Healthcare Access Management Volume 33, Number 1

NAHAM BoArd of directorsJulie Johnson, BSHA, CHAM, PresidentPamela Carlisle, CHAM, Vice PresidentJeff Ferrell, CHAA, CHAM, SecretaryEd Spires, CHAM, TreasurerKatherine Murphy, CHAM, Executive DelegateMaxine Wilson, CHAM, Immediate Past President

and Conference ChaircoMMittee cHAirsPolicy development/Government relations committeeBrenda Sauer, CHAM

certification commission Holly Hiryak, RN, MNSc,CHAM

education committeeTammy Wood, CHAM

Publications/communications committee Jim Hicks, CHAA, CHAM, CAM

Membership committee Patricia Consolver, CHAM

special Projects committee Antionette Anderson, CHAM

reGioNAl deleGAtesNorthwest regional delegateKathryn Stevens, PhD, MBA, CHAM

southeast regional delegate Betty McCulley, CHAA, CHAM

Midwest regional delegateKatherine Murphy, CHAM

central regional delegateJeff Brossard, CHAM

southwest regional delegate Yvonne Chase, CHAMex-officiolegal counsel Michael J. Taubin, ESQ

editoriAl BoArdJim Hicks, CHAA, CHAM, CAM

Chair, NAHAM Publications/Communications Committee, Southeastern Regional Medical Center, Lumberton, NC

Donna Aasheim, CHAM St. Louis University Hospital, St. Louis, MO

Terri Boyd, RN, BSN, CHAM Altarum Institute, Alexandria, VA

Tony Lovett, MBA, CHAM Cypress Fairbanks Medical Center, Houston, TX

Betty McCulley, CHAM Trinity Medical Center, Birmingham, AL

Brenda Sauer, RN, MA New York – Presbyterian Hospital, New York, NY

NAHAM NAtioNAl officeExecutive Director: Steven C. Kemp, CAEProgram Manager: Mike CoppsProgram Associates: Caroline Fabacher, and Nikki SantoMarketing and Communications Manager: Heidi WunderEducation and Program Services Senior Coordinator: Joyce Arawole

Access Management Journal (ISSN 0894-1068) is published by:

National Association of Healthcare Access Management2025 M Street, NW, Suite 800Washington, DC 20036-3309Telephone: (202) 367-1125Fax: (202) 367-2125Web site: www.naham.org

© Copyright 2009, National Association of Healthcare Access Management.Indexed in Hospital Literature Index, produced by the American Hospital Association in cooperation with the National Library of Medicine.

The printed edition of Access Management Journal is not to be copied, in whole or in part, without prior written consent of the managing editor. For a fee, you can obtain additional copies of the printed edition by contacting NAHAM at the address provided.

The National Association of Healthcare Access Management (NAHAM) was established in 1974 to promote professional recognition and provide educational resources for the patient access services field.

The Access Management Journal subscription is an included NAHAM member benefit. NAHAM 2009 membership dues are $165 for Full Members and $1,500 for Business Partner Members. For more information, visit www.naham.org.

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Greetings NAHAM members,

Idon’tknowaboutyou,butI’mfindingthatit’sonlyMarchandmy2009calendarisalreadyfillingup.BetweencompulsoryworkmeetingshereinNorthCarolina,mycommitmentstotheBoardofDirectorsofbothNCAHAMand NAHAM, and my desire for a few days here and there for vacation or family commitments, I pretty much alreadyknowhowmyyearisgoingtoplayout.AsIsitbackandlookatmyrapidlymarked-updayplanner,I’mabitovercomebyhowmuchworkIhavetodoandhoweachweekseemstogobyfasterthanitdidlastyear.

Ofcourse,that’sjustwhat’sonmyplate,thankstoajobIenjoyandvolunteeropportunitiesthatIfindrewarding.I’msureI’mnotaloneinhavingalonglistofprojectsthatI’dliketodothatcouldpositivelyimpactmyday-to-dayworkandthatofthepeoplewhoworkherewithme.IgetallsortsofgoodideasfromwebinarsandmeetingsthatIattend,andarticlesthatIreadinthispublicationandinotherindustrymagazines.Th ethingisthatalongwiththesesubscriptions to publications and listservs, there’s no way to sign up for more hours in the day.

In this issue of the NAHAM Journal,ourcontributingauthorsdiscusssomewaysforyoutoenhancetheinner-workingsof your Access departments and improve the relationships among your team members. Articles cover better interviewing ofcandidates,providingarewardingcareerpathtotheemployeesyoualreadyhave,andre-examiningtheentireAccessprocessforoneimportantsubsetofpatients,amongothers.Isuspectthesearticleswillaffectyouinthesamewaytheyaffectme—theygivemelotsofgreatideasbutfewanswersonjusthowtofitthemintothat2009calendar.

Perhapsmanagingahighvolumeofworkisareasonwhywearehere,together,inNAHAM,andwhywehaveateamgatheredaroundusintheworkplace.Noneofushastodoeverythingbyourselves.Wehavecolleagueswithwhomwecansharetheworkload,andfellowNAHAMmembersfromwhomwecangetopinionsonourbrightideas.OnceIrememberednottothinkofmycalendarassolelymine, but rather as ours, I began to see the sunshine through the clouds.

Inanefforttoassistyouinbringingyourteamontothefield,theNAHAMJournal is launching a Discussion Guide. Th issupplementpublicationismeanttobeahandywayforyoutotakewhatyoureadinthismagazineandtalkaboutit with your team. Get their input on the areas of discussion and, more importantly, get them to see their roles in ownershipoftheprocess.Forexample,youmightsharethearticleoncareerladderswithyourteamandconcludethatyourjobdescriptionsorpaygradesneedupdating.It’slikelythatafewinyourgroupwereactiveparticipantsinthatdiscussion;namethemastheprojectleadstogetthisstarted.Youmightjustfindthatour2009calendarisnotnearlyas crammed as yourswasjustashorttimeago.

With sincere best wishes,

JimHicks,CHAA,CHAM,CAM

P.S.We’reproudtooffersuchadiversityoftopicsintheNAHAMJournal.PleasejoinusattheNAHAMAnnualConference in May, where your exposure to a breadth of topics and ideas will be even wider. While education tops the listofactivitiesinLasVegas,youcanplaceyourbetsthatyou’llfindthenetworkingandinformationfromexhibitorsattheAccessSolutionsMarketplaceequallyworthwhile.

Jim Hicks is the Patient Access Manager for Southeastern Regional Medical Center in Lumberton, North Carolina, and serves as the Communications Chairman on the North Carolina Chapter of Healthcare Access Managers (NCAHAM) Board of Directors.

Editor’s Letter

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Why Use a Career Ladder in Access?PatientAccesshasbeenanoverlookedsegmentof the revenue cycle for many years. As recently as three years ago, many hospitals used Access as a place to get a patient into the system for the clinicians to begin delivering care and revenue cycleemployeescouldgatherdataforbilling.Forexample,rememberthosepre-billingpositionsthatreviewedthechartsandfixedthedata?OrlandoHealth has always had a progressive Access department, and to remove obsolete positions, we implementedanewcareerladder.Thisnewsystemserves as recognition of each employee’s important role in the revenue cycle.

Foralongtime,Accessdepartmentswereasteppingstonewithinanorganization.Thepaylevelwaslessdesirable,suchasthatofanentry-level position. Employees could transfer to other departments after six months (sometimes less), which resulted in a high turnover rate. A change wasneededtoimprovethesystem,soweanalyzedthe situation to determine:

Where we were in Access; y

What aspects of the department needed ychanging; and

How to implement the necessary changes. y

Where We WereWeweremorethanjustadepartmentthatadmittedpatients.Wealsocollectedco-pays,deductibles, we completed patients’ financial statements, verified benefits, counseled patients on denial and billing issues, and addressed other patientbusinessissuesoutsideofthecurrentjobdescription.Takingtheseresponsibilitiesintoconsideration,managementrecognizedthatsomeemployees would be of great value if retained in our department.

Where We Wanted To Take the DepartmentOurstaffincludedmemberswhowerelookingfor advancement opportunities that we couldn’t providebecauseLeadandSupervisorpositionswere rarely available. Motivated employees need the opportunity to move to the next level, and we knewwewouldlosesomeofthosegreatworkersifthey weren’t moved up.

Themanagementteamthenspenttwodaysevaluatingthedepartmentandeachjob’sfunctions.Intheprocess,werealizedtherewerethreeseparateemployeelevels,sowerevisedthejobdescriptionstodevelopandformalizeanentry-levelposition,FinancialCounselorI;aFinancialCounselorIIposition,foremployeeswhotakeonadditionalresponsibilities;andaFinancialCounselor III role for the star performers, the ones whowillingtoworkatanyOrlandoHealthfacilityandcontributetoprocessimprovements.SeeTable1for a sample listing of employee responsibilities andqualificiations.

Developing a Career Ladder in Patient AccessBy Craig Pergrem

Solidify your employees’ job responsibilities for a successful, happy work environment.

Continued on page 6.

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Can everyone be a Financial Counselor III?Probably not. Nonetheless, a successful department has strong employees at all levels, and Patient Access is no different.

Getting To the Next LevelOnce the job descriptions were written andapproved, our executive team met with Human Resourcestopresentourplans.Thesenewly-solidified roles were not only pertinent to Access, buttotheorganizationasawhole.Recognizingeachemployee’sroles,responsibilities,andjobdescription helps each member better service patientsatamuchhigherlevel.Wealsoknewthatthe future leaders would rise to the top, and we wanted to provide them the opportunity to do so byenhancingtheirknowledgeandskilllevel.

WhileHRdevelopedcompetitivejobcodes,weworkedoutthedepartmentaldetailsthatdidnotdirectlyfallintothejobsonthecareerladder. Using the new career ladder, an area can haveasmanyFinancialCounselorI,II,andIIIlevel employees as needed for the department. Advancinguptheladderisanemployee-drivenprocess, and each staff member is responsible for achieving the guidelines and presenting his credentials to management when ready to move to the next level.

Guidelines leading to a promotion include:

It is the responsibility of the employee to yycomplete requirements under the supervision ofmanagement within the department.

Financial Counselor II Financial Counselor III

Employed within Patient Business (Access) for a minimum of 6 months.

Employed within Patient Business (Access) as a Financial Counselor II for a minimum of 6 months.

Meets or exceeds all Departmental Individual Goals for FC I, as well as all parts of the FC I job description.

Meets or exceeds all Departmental Individual Goals for FC II, as well as all parts of the FC II job description.

No written counselings within the last 6 months.

No time and attendance counselings of any kind within the last 6 months.

No written counselings within the last 6 months.

No time and attendance counselings of any kind within the last 6 months.

Maintain a RQi (QA) score for 3 consecutive months of: Discharged – 95% Billed – 99%

Maintain a RQi (QA) score for an additional 3 consecutive months:

Discharged – 98% Billed- 99%

Needs to have patient business (Access) involvement outside of daily work activities (committees, feedback sessions, train the trainer, etc.)

Achieves and maintains proficiency in all Access areas within facility.

Achieves and maintains proficiency in designated registration areas within the facility as deemed appropriate by the manager.

Work at least 3 8-hour shifts in another patient business (Access) facility within a 12-month period (determination of those areas worked are at the discretion of the Manager).

Work at least 3 8-hour shifts in Patient Accounting within a 12-month period.

Table 1: Access Management Job Qualifications and Prerequisites

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Departmental needs override training which may yyresult in canceling or rescheduling of any part of the process.

All requirements must be complete, reviewed,yyand approved by the Patient Business (Access)Manager before the employee is promoted.

Promotions may occur any time during the year, yynot dependant on coaching plans.

Departments are not restricted in the number of yyjob codes. Employees do not have to wait untilaFinancialCounselorIIIleavestoapplyforthepromotion.

Therequirementsforeachpositionneedtobeyymaintained after the promotion occurs (QA scores, yearly rotations in PA, etc).

There are many competent, long-term FinancialCounselor IIs who are happy at their current level. Throughoutthelastfouryears,ourFinancialCounselorIIIlevelhasbeenatornear10%ofallFinancialCounselors.Turnoverinourdepartment has decreased each year since the implementation of the career ladder, and the staff is proud of its accomplishments, excited to be a part of the Access team.

Why a career ladder in Access? The departmentrevolves around the team and its members, and hardworkdeservestoberewarded.Ifyourstaff is responsible, reliable, and ready for more responsibility, you will retain them with a career ladderinplace.ThisprocesshasbecomeavitalpartoftheOrlandoHealthAccessdepartment,andI recommend this system for any office.l

Craig Pergrem, MBA, CHAM, is the Corporate Director of Patient Business with Orlando Health (OH) in Orlando, Florida. He has responsibility for Centralized Scheduling, Pre-registration, In-house Verification, Reference Lab Billing and all Access areas in the seven hospital system. Craig Pergrem has been with OH in the Access area for almost two decades. Craig currently serves as Past-President of FAHAM after having served as President for two terms. He can be reached at Craig.pergrem@orlandohealth.com.

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Maternity admissions should be an exciting and wonderful time for new mothers, and admittance intoPatientAccessmarksthefirststepoftheirparentingexperience.Theregistrationandadmittance procedure, however, has not always been a smooth or pleasant process for either the patients orthestaff.RecentlymyPatientAccessteamtookstepstoimproveandquickentheseprocedures,creating a much more positive transaction for all involved.

A Glimpse of the Old ProcessAn expecting mother’s routine visit to her obstetrician revealed some reasons for concern, sendinghertothehospitalforobservation.Sheenters the waiting area, her husband pacing nervously around her. Her bags at her feet, she waits expectantly for her name to be called. Twentyminutespassbeforereceptioncallshertoregister. Arriving at the counter, she f rantically digs through her bags for insurance and ID cards while impatiently confirming her address and contactinformation.Afteranother10minutes,she reaches the labor and delivery suite.

Patient Access Today An expectant mother’s routine visit to her obstetrician revealed some reasons for concern, and sheissenttothehospitalforobservation.Thewoman and her spouse go directly to the labor and delivery suite of the hospital, and within five minutes of their arrival, the expectant mother is in her bed with a fetal monitor attached. Her once-worriedhusbandisnowsettledintoarecliner at her side, accepting refreshments f rom thenursingstaff.Therearenopaperstosign,no cards to be provided.

Twoyearsago,thefirstscenariowascommonplaceatourfacility.Obstetricalpatientswouldarriveat all hours for observation multiple times during thelastdaysoftheirpregnancyfor“falsealarms.”During the day, women waited in the Patient Access area to be registered. At night, nursing escorted patients in to the Emergency Department directlytotheLaborandDeliverysuitewithoutallowing Access staff the time to complete a registrationandobtaintherequiredsignatures.Staffwaslimitedduringnon-peakhours,forcingthe registrar to leave her area for long periods of time to complete the patients’ registration process.

TheprocessforadmittinganOBpatientwastime-consumingandawkwardforboththeregistrar and the patient, resulting in numerous staff complaints. It seemed the financial aspect of the visit was more important than the personal significance of the event.

Today,theseissuesarenolongeraproblematHalifaxRegionalHospital.Managementhassince implemented some very simple process changes, improving the experience for both patients and staff.

Updating the Patient Access procedure involved quiteabitofdetectivework.Thefirststeptocreating a solution was to evaluate the process, identifying any policies, rules, or regulations that wouldpreventusf rommakingchanges.AfterconsultingwithLaborandDeliverystaff,HealthInformation staff, Corporate Compliance, and PatientFinancialstaff,wedeterminedthatthis

Maternity Access, Then and NowBy Susan Franklin

Access Management is now taking vast measures to improve today’s maternity admissions.

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process, like many others, was practiced for noother reason than because that was the way it had always been done.

Not finding any identifiable barriers to change, webeganworkonanewflowforthesepatients.Insteadofrequiringapatient ’ssignatureateachvisit,managementnowonlyrequestssignaturesduringthelasttrimester.Patientsarepre-registered in person for their delivery at any time within the last three months of the pregnancy. Duringpre-registration,staffrequestspatientsto provide their current insurance and ID cards. After the staff verifies all demographic, financial, and contact information, patients sign consent forms and provide a password for HIPAA compliance. Along with the insurance and ID cards, staff scans the signed forms into the system, where patient information is available and used for future visits. As always, the office confirms the patient ’s insurance benefits and eligibility at each new visit, using the information provided during pre-registration.Aslongasthepatientisadmittedforapregnancy-relatedcondition,shewillnotneedto register in Patient Access again.

Ourteamthendevelopedabrochurethatexplainedthe new process and was distributed to all surroundingOBphysicians’offices.Thephysicians’offices give the brochures to their patients approaching their final months of pregnancy.

With the new process in place, patients can now go directly to the labor and delivery suite. When they arrive, nursing immediately notifies Patient Access staff, at which point the staff verifies that thepatientcompletedthepre-registrationprocessbefore assigning the patient an account number. A patient can have any number of new accounts during this period as long as the condition is pregnancy-related.Asaresult,therearenolongeranydelaysinpatientcare.Thenewprocesseliminates the patients’ stress of waiting, allowing parents-to-betofocusontheirnewfamilies.

The results of this change have been phenomenal.Patients,physicians,andnursingstaffadjustedquicklytotheprocess.Whatwasintended solely as a customer service improvement eventually became a significant timesaver for Accessandnursingstaffalike.Afewverysimplepolicy changes refreshed an outdated, inefficient processatabsolutelynocosttotheorganization,becomingaviablemarketingpointforourmaternity services.

Thereisanopportunityeverydaytoimproveservice in healthcare and Patient Access. Identifying inefficient, obsolete processes and makingtheappropriatechangeswillsetyourhospital apart as a leader in customer service, employee relations, and productivity. l

Susan Franklin, CHAM, is Patient Access Coordinator at Halifax Regional Hospital in South Boston, Virginia. She has worked in Healthcare for 20 years, having began her career in patient care as a Cardiac Technician with a local Rescue Squad. Franklin spent many years as an office manager in a large, hospital-based outpatient rehabilitation facility before moving to Patient Access.

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Hiringtherightpersonfortherightjobhasbeen a constant challenge in the Patient Access Servicebusiness,anindustrythathassufferedahighturnoverrateforyears.Tosolvethisproblem,theIndianaRegionalMedicalCenterisworkingto improve the interview process by putting a largeremphasisoncustomerserviceskills,andtakinggreatermeasurestoassessacandidate’spersonality—practicesthatcanimprovethehiringprocess in any office.

Todetermineacandidate’sbehaviorpatterns,askquestionsthatengageacandidatetotalkaboutpast situations, which will indicate how she will handle stressful situations and whether she gets alongwithothers.Somanynewintervieweeshavebeencoachedandtrainedtofeedyouthekeywordssuchas“dependable,”“quicklearner,”“outgoing,”“trustworthy,”totheextentthatyoufeellikeyou’reinterviewingthesamepersonoverandover.Toavoid this, get the interviewee to answer specific questions,promptinghertocomeupwithexamplesthat support her statements; push for examples! When a candidate can’t provide the answers, perhapsshedoesn’thavemuchworkexperience.

SearchtheInternettofindquestionsthatcandetermineacandidate’sbehaviorinless-than-favorable situations. In a search engine of your choice,typein“behavioralorsituationalinterviewquestions”tofindsitesthatprovideinterviewquestionsthatwillobtaintheinformationyouneed.Suchquestionsinclude:

Howmanyworkdayshaveyoumissedintheypast12months?(IfindthisparticularquestiondisclosesacommonproblemwiththePASdepartments.)

Have you ever been fired or dismissed yf romajob?

Describe a time you were faced with a serious yproblem. Describe the problem, the steps you tooktoovercomeit,andhowitaffectedyou.(ThisparticularquestionhasbeenaneyeopenerforusatIRMC,pinpointing“redflag”personalitytraitsinjobcandidates.Inansweringthisquestion,oneintervieweedescribedaverytrying time in her life that lead her to attend anger management classes. Depending on the reasons and explanation a candidate provides, youmaydiscoversherecognizesproblemsandtakesappropriatestepstoovercomethem.)

Describeyouridealworkenvironment.y

Whatprojectshaveyoubeeninvolvedwith?y(Thendigdeeper,determiningherspecificroleintheproject,andtheproject ’soutcome.)

Thekeytoagreatinterviewisellicitingenoughinformationtofeelasifyouknowtheperson.Thebest advice is to let the interviewee disclose the information on her own accord. Mind you, as with allthings,thisisn’tfool-proof,butacandidatewithadesirablepersonalityandasolidworkethic

Hiring Tips for Building a Successful Team

By Morag Sichak

Learn how to assess a job candidate’s skills, personality traits, and work experience.

Continued on page 11.

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Hiring Tips for Building a Successful Team

will have a much higher chance of becoming a customer-focusedemployee.Mygutfeelingisthatyoucanteachalmostanyonetheskillsneededforthejob,butit ’shardtotransformastatueintoafocused,diligentworker.

Determiningacandidate’sskillsetisessential.HumanResourceDepartmentsoftengivetyping tests and a medical vocabulary tests prior toacandidate’sinterviewwiththethePASManagementTeam.Ifsomeoneonlypecksoutthe letters on the computer, don’t waste your time with an interview. Do, however, consider candidates that have not completed a formal medicalterminologyclass.Someofthesepeopleare naturally great spellers and may benefit f rom an online medical terminology class assigned to new hires. As a condition of hire this online class must becompletedpriortoanemployee’ssix-monthevaluation.Thispracticeallowsustorewardtheapplicants that have done well in the interview process and have passed their typing test, but may not have performed as well on the medical terminology testing.

Tips to Conducting an Effective Interview:

Ask situational and behavioral questions.

Request the candidate to answer in depth with examples and details.

Let the candidate talk. You’ll learn a lot about a person from listening.

Try having potential candidates “shadow.”

Give a pre-hire a typing and medical terminology test.

Consider developing an online medical terminology class.

The Indiana Regional Medical Center allowspotentialcandidatesto“shadow”senioremployees,another helpful tool in the hiring process. Candidates spend at least two hours with a registrar in the Emergency Department, receiving a shadow badgeandsigningaconfidentialitystatement.Theseprospective employees spend time with the staff to seewhatthejobactuallyentails.Staffcanthengivefeedbacktomanagement,whichhasbecomeaverysuccessful part of our interview process.

Implementingrigorouspre-employmenttesting,askingcandidatessituational/behavioralquestions,andofferingtheopportunityto“shadow”employees gives us a much more accurate perception of the candidate and her potential on thejob.l

Morag J. Sichak is Director of Patient Access Services at the Indiana Regional Medical Center. He can be reached at msichak@indianarmc.org.

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InApril2008,theIRSreleasedthedraftinstructionsforcompletingIRSForm990,ScheduleH,whichhasbecomemandatoryforthe2009taxyear.Thisformrequiresnon-profitorganizationssuchashospitalstotrack,audit,andreportallcharity,community benefit, bad debt, and collection practicesasdefinedunderthenewIRSguidelines.ThesenewIRSrequirementswillcreateanumberofpositive changes in a hospital’s operations.

Hospitals now will have an opportunity to finally define and clarify their practices, policies, and workflowregardingcharitycareandbaddebt,establishing a standard operating procedure for theirownuseaswellasfortheIRS.Thenewtaxrequirementsalsoprovideanavenueforhospitalsto clearly articulate and document the value and benefits they bring to the communities they serve onadailybasis.Forfartoolong,thevalueequationhasbeendifficulttoquantify,orit ’sbeenignoredall together.

WhydidittakeIRSinvolvementforguidelinestobeestablished?Answeringthisquestionrequiresalittle history.

Healthcare, Past and PresentTounderstandthechallengesthatnon-profithospitalsfacewhencomplyingwithIRSForm990,ScheduleH,itisimportanttoevaluatethecontinually-changinghealthcarelandscape.

Taxexemptionforhospitalswasoriginallydefinedinthemid-1950sundertherulessummarizedhere:¹

Itmustbeorganizedasanon-profitcharitableyorganizationforthepurposeofoperatingahospitalforthecareofthesick.

It must be operated to the extent of its financial yability for those not able to pay for the services rendered and not exclusively for those who are able and expected to pay.

It must not restrict the use of its facilities to a yparticular group of physicians and surgeons, such as a medical partnership or association, to the exclusionofallotherqualifieddoctors.

Its net earnings must not inure directly yor indirectly to the benefit of any private shareholder or individual.

Theserulescreatedataxexemptguidelineforhospitals that did not charge patients who didn’t have the financial ability to pay for services rendered. As a result, the tax system had created a charity care standard.

Upon the creation of Medicaid and Medicare in 1965,theU.S.governmentprovidednewcoveragefor many of the medically indigent, reducing the amount of charity care services provided to the patientswholackedfinancialresources.In1969,theIRSissuedRevenueRuling69545,whichabandonedcharitycareasthekeyinquiryforexemption.Thenewrulingpromotedthathealthfor the general benefit of the community was in itselfacharitablepurpose.²Thisstandardwouldbecome the basis for the community benefit exemption“test”fornonprofithospitals.³

IRS Form 990, Schedule H Provides Unique Opportunities to Non-Profi tsBy Marty Callahan

New tax requirements will improve hospitals’ recordkeeping systems and patient services.

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Today, the rules for tax exemption are in thespotlightyetagainwiththeintroductionofIRSForm990,ScheduleH.Althoughtheimpactof the tax exemption for hospitals is not fully understood,itisestimatedthatroughly$20billionannually bypasses the federal government coffers under the tax exempt label.4

Accounting Advice For Charity Versus Bad DebtThe challenge for hospitals to properly distinguishbad debt from charity stems from their inability to consistently and accurately separate the two revenue types.Thesedifficultieshavebeencompoundedby the fact that Generally Accepted Accounting Principles (GAAP) do not provide clear guidance surrounding charity care eligibility and bad debt that is specific to the healthcare industry.

OtherorganizationssuchastheHealthcareFinancialManagementAssociation’s(HFMA)PrinciplesandPracticesBoard,theFinancialAccountingStandardsBoard(FASB),andtheGovernmentalAccountingStandardsBoard(GASB)haveissuedguidanceandtheirowndefinitions on classifying charity care and bad debt. Each one, however, has its own strengths and areas ofself-interpretation.

Despite guidance from various healthcare groups, hospitalsstrugglewiththeabilitytoobjectivelyapply their policy, e.g. the entity’s decision to forego revenue, or charity largely based on the individual’s financial ability to pay for services rendered, versus bad debt as a result of nonpayment. Historically, reporting has often led to revenue recognition of amounts never expected tobecollected.Therelatedreportingofbaddebtoften trends significantly above both revenue or expense growth.5

Adding to the lack of clarity around the subjectis human intervention. Manual processes are pervasive within hospital revenue cycle operations, leading to the misappropriation of bad debt and charity.Onecaseinpointisahospitalpolicythat

requirespatientstocompleteacharityapplicationand provide documentation of their financial qualificationstomeetthehospital’scharitypolicy.Patient compliance in completing the necessary documentationmaybesolowthatamajorityofbaddebtshouldhavebeencategorizedascharity.

Category % of Sample Category Description

Meets Charity Guidelines

86% The patient has lower estimated income in combination with estimated family size to fall under hospital’s charity guidelines.

Question Household Income

13% The patient has ability to pay charges in full, however, still falling under hospital’s charity guidelines.

Collectable 1% The patient likely exceeds hospital’s charity guidelines.

Table 1: Patient Elligibility for Financial Assistance: Sample Case Study

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There are many causes of patient non-compliance.If the patient is indigent, they may not provide documentationsuchastheW-2,paystubs,copiesofbills,etc.Othernon-complianceissuesincludea patient ’s discharge flow, or the patient ’s pride, i.e. theirnotwantingtoaskforcharity.Suchissueshave created an operational concern in accounting for charity and bad debt accurately.

SolutionsA hospital’s compliance with IRS 990, ScheduleHinvolvesemployingobjectivesystems,methods,and policies regarding charity and financial aid. Inherent in these systems should be the ability to automate policy and processes, accurately segmenting patient financial class, reducing patient noncompliance, and providing auditable data andreporting.Systemsthatprovidethiskindofbenefit to hospitals are able to process hospital data inabatchand/orareal-timeenvironment.

Table1onpage13providesanexampleofonesuch solution that determined in real time patient eligibility for financial assistance at the time of registration,isTransUnion’sRevenueManager.AMidwest hospital system recently reviewed more than60,000baddebtaccounts,includingbalancesafterinsurancefrom2008.Theobjectiveofthereview was to identify which accounts should have been classified as bad debt and which should havebeenclassifiedascharity.Theresultsoftheanalysiswerestriking—86percentoftheaccountsqualifiedforcharity.

While reclassification of bad debt accounts to charityforIRSreportingpurposesiscontingentupon on hospital policy and auditor review, results likethesearenotuncommon.Inatleastthreeotherstudiescompletedin2008,morethan75percent of bad debt accounts were determined tomeetthehospitals’charitypolicy.ByusingsystemslikeRevenueManager,hospitalsareableto achieve greater efficiencies, gain assistance in complying with regulatory demands, and to achieve greater patient satisfaction by offering them the appropriate financial assistance at the

time of service. Other advantages include moreaccurate community benefit reporting that may lead to alternative hospital reimbursement such as DisproportionateShareHospitalfunding.

Theglassiseitherhalf-emptyorhalf-fullwhenitcomestocomplyingwithIRSForm990,ScheduleH.Althoughthenewdocumentreportingrequirementsprovidesomechallengesthis year, it also creates opportunities for hospitals to review and further define their practices and policies, and to possibly implement automated proceduresthatcansavetimeandmoney.Byusingtheserequirementsasameanstoimprovetheiroperations, hospitals may find more benefits than problems going forward. l

SourcesRevenue Ruling 56-185, 1956-1 C.B. 2021.

Non-ProfitHospitals,TaxExemptionand2.Access for the Uninsured: Pitt Health LawCertificateProgram10th Anniversary Symposium,Feb.5,2007.MaryCrossley

Revenue Ruling 69-545, 1969-2 C.B. 1173.

See4. NancyM.Kane,TakingthePulseofCharitable Care and Community Benefit AtNonprofitHospitals,StatementtotheU.S.Sen.Comm.OnFinance2(Sept.13,2006)(estimating the value of exemption from all sourcesasapproaching$20billionperyear). But seeRichardL.Schmallbeck,The Impact of Tax-Exempt Status: The Supply-Side Studies, 69L.&Contemp.Probs.121,131(2006)(suggestingthat“notmuchrevenueislostdue tothe[§501(c)(3)]exemption”)

HFMAForm990ScheduleHCitesHFMA’s5.BadDebtReportingGuidance.Jan.23,2008.

Marty Callahan is a vice president of Healthcare Information Solutions for TransUnion. Callahan can be reached at mcallah@transunion.com.

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A Standardized Health Identifi cation Card on the HorizonBy Jim Hicks

The Workgroup for Electronic Data Interchange is creating a new standard for access services, which poses advantages for patients and employees alike.

InNovember2007,theWorkgroupforElectronicData Interchange (WEDI) introduced an implementation guide for a standard Health IdentificationCard.Thisnewtechnologypromisesmany benefits to providers, but may pose several hurdles before providers will receive its benefit. TherearemanyadvantagestothenewIDcards,however, including machine readability, increased security,andimprovedefficiency,whichmakeitworthwhile to Access Management.

The ChallengesOneofseveralchallengesstilltobeovercomeisthattheHealthIDcardreliesonANSIStandardINCITS284(alsoreferredtoasANSI284)asanunderlyingstandard.ArevisionofANSI284isexpected,asearlyasFebruary2009buttherearenoconfirmed release dates.

Anothermajorhurdlewillbevendor/softwarecompatibility.Forthemachinestoreadthecardsand retrieve the data within, vendors may have to upgradesoftware.Themachinesaccessthedataviathecard’s3TrackMagneticStripeandPDF417bar codes.

3TrackMagneticstripeissimilartoyourcreditycard,whichincludes3tracksofinformation:Tracks1and2aregenerallyusedforbankcardinformation,whiletrack3isusedfortheHealthID Card.

ThecardwillberequiredtoincludeacardyIssuer Identifier (discussed in more detail later), a Cardholder ID (policy or claim number), and a cardholder name. Additional information such

as a date of birth may be included as an option butitwon’tberequired.

ThePDF417barcodeissubjecttothesameyrequirementsasthemagneticstripe.Theimagesbelow are an example of a Provider issued card withaPDF417barcode.

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The ID card’s third obstacle, as I see it, is creatingaCardIssuerIdentifier.Thisnumberisunique to each card, similar to an NPI number for insuranceplans.TheCardIssuerIdentifieris notcurrentlyrequiredbyanylegislation,but an upcoming Web site (www.enumeron.com) will eventually issue the standard health plan identifiers.Theseidentifierswillissuespecificplans,notjusttheoverallcarrier.

Thefinalchallengeisthatadoptionisvoluntary.Card issuers may choose not to adopt the standard format. Providers may adopt them through contracts and grass roots campaigning with large employers.

The BenefitsMachine readability on its own provides a substantialbenefitinrecordkeeping,asitreducestypos and transposed numbers that may occur as aresultofhumanerror.Surprisinglyenough,thistechnologyisdecadesoldandalreadyusedinjustabout every other business environment imaginable. Thesystemisusedtofacilitatebusinesstransactions, anything ranging from discounted grocery purchases to account identification at the video store. Combining this feature with a plan IDopensanewworldofopportunities—imaginenever having to worry about patient insurance informationagain.Aninstantfail-safe,theIDcard pulls the correct plan from your insurance databaseinyourADTsystem.IfthereisnomatchinyourADTsystem,anautomatedtransactionwill download and build the plan into the system to include electronic payor codes, billing addresses, and phone numbers, before sending a report to your billing manager / plan administrator to fill in any facility specific optional fields. At the same time your eligibility system will pull down benefits information.ThisprocesswillkickoffassoonasyouacknowledgethesinglepatientreturnedbythehostADTsystemisinfactthecorrectpatient.Having matched the card holder name, card holder ID, and possible other patient identifiers embedded in the machine as readable data, the ID card leaves very little room for error.

Theoptionalphoto,personalPINnumber,andpossible record of a palm vein scan or other biometric verification method will increase the security of the card and the patient ’s information. Combining this technology with other automated transactionssuchasaddressandcreditchecks

can also expose attempts at ID theft. OWLverificationquestioning(OutofWalletLogisticsverification) is another possible security measure in which confidential information that cannot be retrieved from a stolen wallet is provided to a registrar, and the card holder must confirm to provehisidentity.Somevendorsareworkingtooffer this service to providers, although this feature is not widely practiced in Access services.

The Provider’s ResponsibilityProviders have an important role to play in adopting this technology. Although there is no confirmedreleasedateoftheANSI284standardand the issuance of the Health Plan Identifiers, theseservicesshouldbeinplacebytheendof2009orearly2010.

Even in advance of these conditions being met, providers must verify with their vendors how they intendtoadoptapplicationstotakeadvantageof machine readability. Although vendors are probablywaitingontheANSI284standardrevision before beginning their programming initiatives,muchofthegroundworkcanbecoveredprior to the release date.

HRdirectorsandbenefitsmanagersneedtoknowaboutthenewstandard.Theycanthensharetheinformationwithassociatesatnon-healthcareorganizations.Oncealltheothercriteriaarecompleted, providers will no longer need to issue new cards to their personnel if it does not comply with the standard. Also, the largest employers in your region need to become aware of the standard, the technology, and its benefit to employees. Makingtheseservicesbetterknownwillhelpspeeditsadoption.Themorepeopleknowaboutit, the further it will progress through various professional channels. l

Jim Hicks, CHAA, CHAM, CAM, is the Patient Access Manager at 425-bed Southeastern Regional Medical Center in Lumberton, NC, serving as a Board Member for both the National Association of Healthcare Access Management and the North Carolina Association of Healthcare Access Management.

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Most hospital administrators are probably awarethatbarcode-basedpatientidentificationwristbands have made great strides in promoting patientsafety.Byensuringaccurateidentificationof patients throughout the care process, bar coded wristbands provide the foundation for preventing errorsduringsuchroutinetasksasmedicationadministration and specimen labeling. According tothe19thAnnualHIMSSLeadershipSurvey,barcode technology continues to be at the forefront of manyhospitalITinitiatives.Infact,35percentofrespondents planned to adopt bar code technology at their hospitals within the next two years.

At the same time, the healthcare industry has recognizedthatmoreenergy-efficienttechnologiescan reduce waste and lower operating costs, often enhancing staff productivity in the process. Accordingtothe2008HealthcareEnergyEfficiencyIndicatorstudy,publishedbyTheAmericanSocietyforHealthcareEngineeringandJohnsonControls,two-thirdsofhealthcareorganizationsplannedtospendcapitalonenergyefficiencyin2008.

What many hospital administrators may not realizeisthatusingthermalprintingtechnologyto produce bar coded wristbands combines the best of both worlds. It has the potential to not onlyenhancepatientsafety,butalsotobeamajorcontributortoahospital’s“green”strategy.

Reducing Materials Consumption and WasteLaserprintersaretypicallyusedinmostadmissions departments, and a common approach to printing bar coded patient wristbands is to add an additional tray to the existing laser printer. However,thisisnotalwaysthemostcost-orenergy-efficientoption.

In comparison to laser printing methods, thermal printing technology can provide substantial savings in print media and materials. Most laser printers, for example,mustprintonfullorhalf-sheetsoflabelsratherthanonsinglelabelsorwristbands.Soeachtime a patient is admitted, the machines produce unusablelabelsorwristbandsthatstaffmusttrackand destroy in compliance with HIPAA guidelines. Incontrast,thermalprintersaredesignedfor“on-demand”printing,generatingonlythelabelsorwristbandsneededatthatmoment—significantlyreducing materials waste and saving staff time because there are no labels or ribbons to destroy.

Inaddition,unlikelaserprinters,thermalprintersdonotrequireinkortoner.Thisisakeyconsideration given the difference between printing text and bar code symbols. While text printing requiresonlyaboutfivepercentblacktoner,barcodescanrequiremorethan30percenttoensurepropercontrastbetweendarkandlightelements.When using a laser printer to produce bar codes, toner costs alone could be as much as six times higher than when printing regular text documents. Tonercartridgesarerecyclable,butcanincurmanyassociated environmental and business costs such as manufacturing,transportation,on-sitestorageandstaff time spent replacing toner.

Going “Green” in the Access DepartmentBy Kathleen Trotter

Bar coded wristbands are making their mark as an environmentally friendly technology for patient identification.

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In terms of maintenance and materials cost, laser printers are bigger consumers than thermal printers once again. A laser printer’s fuser mechanism, among the most costly items that need periodic replacement, generally needs to be replaced more frequentlythantheprintheadofathermalprinter.In addition, because stored media can get moist, the adhesivemaysticktothefuser,whichisverytime-consuming and expensive to clean.

A full calculation of materials waste must also include redundant printing. In a hospital setting, this usually occurs when a label or wristband isdamaged,requiringittobeprintedasecondtime.Manylaser-generatedbarcodedwristbandsrequiretape,adhesive,orapplicationofalaminateoverlay to protect them from elements commonly encounteredinthehospitalsetting—e.g.,water,soaps,disinfectants,orheat.Theseimprovisedsolutions,however,tendtowrinkle,crease,orfallaparteasily,makingthemunreadablebybarcodescanners.Thermalprinters,ontheotherhand,aredesignedtoprintonspecializedtypesoflabelsorwristbands that are more durable when exposed to environmental elements, designed to remain readable for longer than the average patient ’s stay.

Optimizing Energy EfficiencyWhen calculating the carbon footprint of a printer, it ’s important to focus on materials consumption. Also, there is another component to going green that must be considered: energy consumption.

Onesimplewaytoincreaseenergyefficiencyistochooseaprinterthatisbest-suitedtothespecificfunction within the hospital. As noted previously, some admissions departments use laser printers to generate bar coded wristbands for patient identification.However,inadditiontorequiringfewer materials and producing less waste, dedicated thermalprintersaretypicallyamoreenergy-efficient option when compared to laser printers.

When in operation, popular desktop laser printersconsumeanywheref rom300to600watts.Thepowerconsumptionofthermalprintersismuchlower,butmorevaried.Theirreportedspecificationsrangefrom30to120watts,dependingonthesizeoftheprinter.Becauselaserprintersremain“warmedup”foraperiodoftimeafter each print, their energy drain is compounded. When the printer is not in continuous use, that energyislost.Thermalprinters,however,requirefewer moving parts than laser printers, they don’t requirewarmuptime,andgenerallyconsumelessenergythanlaserprinting—makingthemanenvironmentally f riendly option for settings where theyareusedonanas-neededbasis.

Saving Valuable SpaceIn addition to materials and energy savings, thermalprinterssavespaceintheoffice.Thermalprinters for admissions are significantly smaller and lighter than their laser counterparts, enabling healthcareorganizationstoeasilymoveandhousethem. In fact, many thermal printers are small enoughtoplaceonanadmissionclerk’sdesk,soeachclerkcouldhaveherownwristbandprinterwithouthavingtowalktoacentrally-locatedlaser printer for the wristband. Not only does this approachenhanceworkflow,butitalsoincreasesoverall efficiency.

A Green Light for ChangeAs awareness of the importance of minimizingwaste and conserving energy increases, hospitals arelookingfornewwaystogogreenwhilealso reducing costs, enhancing productivity, and ensuring patient safety. In today’s hospital admissionsoffices,utilizingthermalprintersforbarcodedpatientwristbandgenerationisjustoneof the many ways to become more ecologically responsible–while also preventing errors by ensuring that accurate patient information is available at the point of care. l

Kathleen Trotter is business development manager at Zebra Technologies, a leading provider of thermal bar code and RFID printers, and specialty labels and wristbands, based in Vernon Hills, IL.

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Advocacy Update

Many NAHAM members participated in the Issue PrioritizationSurveyfor2009.Ourgovernmentrelations staff will use this data to establish issue focus and ensure NAHAM advocacy presence in Washington best meets members’ needs and concerns.

Exciting, New LegislationThe upcoming legislative environment will bringmuch attention, action, and movement related to NAHAM’s core issues. As the new Congress and administration set course for this year, a critical areaoffocuswillbeamajorhealthcarereformpackageincludinghealthinformationtechnology(HIT)issuesandpossibleMedicarereforms.NAHAM has the opportunity to engage in this debate, discussing the issues of privacy, proper identification of patients and providers, and maintaining secure, accurate, dependable health records.

Plans for the Near FutureThe NAHAM Government Relations Committeeand leadership have the ability to bring increased focustothesekeyissues.NAHAMwillleveragethe changing political landscape to become involved in policy activities by influencing legislation and regulation. NAHAM will be the vehicle through which access managers affect policies and improve overall healthcare in America, primarily concentrating on patient access to care.

Staytunedtowww.naham.org, for detailed Issue PrioritizationSurveyresultssoon,andaNAHAMAdvocacy action plan that establishes NAHAM’s core issues at the forefront of policy development. NAHAMwillcontinuetokeepthemembershipupdatedontheseissuesandallotherhealthcare-focused legislation relevant toyourday-to-daywork.Asalways,pleasefeel f ree to contact our government relations staff at (202)367-1175withquestionsorcomments.l

Chris Krueger is NAHAM’s Government Relations Manager, based in Washington, DC.

NAHAM Focus on Healthcare Reform in the New AdministrationBy Chris Krueger

NAHAM is taking action on new policies in 2009.

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About You Name: Charlene Cathcart, CHAMTitle:DirectorofAdmissionsandRegistrationHospital:PalmettoHealthRichlandLocation:Columbia,SCWeb Site: www.palmettohealth.orgDegree and College Attended:BachelorofScienceandBusinessAdministrationfromPresbyterianCollegeinClinton,SCCurrent member of NAHAM?Yes,andPresidentofSCAHAM(SCChapter)

About Your Hospital What is new and exciting at your hospital 1.or health system?We have three hospitals in our health system hereinSC–Richland,Baptist-ColumbiaandBaptist-Easley.Weareveryfocusedonourvision statement and our employees live and breatheit.Also,inJune2008,weopenedaseparate building for our Children’s Hospital here atRichland.Thiswasasignificantimprovementbecause we previously operated our children’s area from two floors of our main hospital building.

What is it like to work for your hospital 2. or health system?I love what I do. I was hired by Palmetto inAugustof1987andhavebeenwiththemeversince.I’veworkedinmanydifferentdepartments in the healthcare system, which has givenmeagreatperspectiveofwhatitisliketowalkinotherpeople’sshoes.Thisisaverydynamicorganizationandeverydayisanewadventure.Idoenjoyit.

About Your CareerWhat is your business philosophy?3.Always try to do the right thing.

What is the best way to keep a 4.competitive edge?Stayontopofwhat ’sgoingoninyourprofession, and try to learn about departments ofyourown.Ihavetheuniqueopportunitytobeapartofourquarterlyleadershipinstitutemeetings, and I really find value in learning about what other areas of the hospital are doing. It helps mold our approach to meeting the changing needs of the hospital in general.

How do you measure success?5. Fromacareerperspective,Imeasuresuccessbased on employee and patient satisfaction, point of service cash collections, and days inaccountsreceivables.Onapersonalnote,success is more about meeting my goals and doing what I love. I am fortunate to have both of these.

What are your biggest accomplishments 6. in the last 24 months?In addition to the Children’s Hospital, we also opened a new Heart Hospital. We are veryproudtoberecognizedasoneofthetop100bestplacestoworkaccordingtoModern Healthcare.Finally,wehavebeenabletoreducemortalityratesby34%,andonaveragewecollect1.15%ofnetpatientservicerevenue.There’salottobeexcitedabout.

NAHAM Member Spotlight: Charlene CathcartBy Brian Shannon

“NAHAM Member Spotlight” shares professional insights and fun facts from NAHAM member Charlene Cathcart.

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What has been your biggest business 7.lesson learned?Makesurethatyoucanmeasureanygoalsyouhave for yourself or your team members. If you cannot measure the goal, then there is no point in having the target to begin with.

What is your career advice?8. Do what you love and be passionate about your work.Ifyou’reonlyinitforthemoney,thenyou’ll be disappointed down the road.

What do you like least about your job?9. Sittinginmeetingsanddealingwithpeoplewhodon’twanttomakeadecision.

What do you like most about your job?10. Touchingpeople’slives.Forexample,ifIcanhelpapatientorafamilyqualifyfora government program to pay for service, that ’s a win. I always focus on ways to help patients and employees have great outcomes. Fortunately,Iaminajobthatallowsmetodothis regularly. In fact, Palmetto embraces the “ConnectaPurposeStories”concept,andweshare wonderful anecdotes with one another often.

When you were young, what did you want to be 11. when you grew up?Thecenterofattention.

More About You:What is your pet peeve?12.Peoplewhocannotgettoworkontime.

What are your greatest passions in life?13.God, my husband, and my team of employees.

What is your favorite quote?14.“Inreality,perceptionisallthatmatters.” –AttributedtoTomPeters

What is your favorite book?15. Asakid,IlovedtheTrixie Belden seriesbyJulieCampbell and Kathryn Kenny. Now, I really enjoyanybooksbyJonathanKellerman’sAlex Delaware series, or Catherine Coulter’s Sherlock FBI series.

What is your favorite movie?16. RebeccabyAlfredHitchcock.It ’sareallyoldmovieandIlovetheblackandwhiteversion.ThereissomethingaboutmysteriesandtheneedtofiguresomethingoutthatIlikeaboutmovies in general.

What is your favorite way to spend your free 17. time?Ilovetoread.IalmostalwayshaveabookwithmebecauseIcanreadjustaboutanywhere.Also,Ienjoygoingtothemovieswithmyhusband.

If you could meet anyone, who would it be?18. Hardquestion—butIthinkMargaretThatcher.I read an article about her that said she was unbelievablyluckyandthatisoneofthereasonsthatshemovedintopower.Althoughweknowthe truth – she was smart, determined, and had theamazingabilitytotalkpeopleintodoingwhat she wanted.

If you could change one thing about yourself, 19. what would it be?Idon’thaveagoodpokerface.YoucanalmostalwaystellhowIfeelaboutsomethingjustbylookingatme.Also,ItendtosaywhateverisonmymindandperhapsIshouldthinkmorebeforeIspeak.

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About NAHAMWhat do you like most about NAHAM?20. TheabilitytogainaccesstopeoplewhohaveasimilarjobasIdo,butarebasedinadifferent part of the country. While their title may be the same, their set of experiences may be very different. I love that variety and the opportunity to learn from others in that way.

What is your favorite NAHAM event or 21. memory?ItwastheNAHAMannualeventinFloridabackin2005.IrememberWaltEdgefromStandardRegisterdoingkaraokeinf rontofallofus.Hewasreallygoodandwegotakickoutof listening to him.

Membership

What can NAHAM do to make itself better?22. Overall,NAHAMdoesawonderfuljob.IfI could change anything, it would only be to reduce the pricing for membership and/or for events.Iknowtherearefolksouttherewhowouldliketoparticipatemore,butdon’thavethe funds to do so.

Are there any other comments that you would 23. like to share?Youareonlyasgoodasthepeopleonyourteam and I am blessed to have such wonderful colleagues.Theytrulymakemyjobeasierandthey’re a big reason why I love what I do. l

Brian Shannon is the President of a Division of EJB World Trade, a professional sales organization specializing in healthcare. He is a member of the North Carolina chapter of NAHAM and lives in Charlotte.

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CHAA Corner

A Symphony of TrustHow much do you trust your staff and why does itmatter?Trustaffectsyourentirebusiness,astheway you treat your employees is the way they will treatclients.Ifit ’sacceptablethatanorganizationormanagerdoesn’thavetokeeppromises,thenyoucanguaranteeemployeeswon’tkeeppromisestoclients, either.

People do business with those they trust. A client ’s trustinanorganizationreflectsanorganization’strustinitsemployees.LanceSecretanstatesinReclaiming Higher Ground,“Oursocietyissufferingfromtruthdecay.”Heholdsthat,especiallyin teams, telling the truth is essential to good business.“Ifthemembersofasymphonylietoeachother,theywillplayawfulmusic,”hemaintains.Soit goes in any team environment.

Tellingthetruthisefficient.Morethanathirdofanorganization’sbudgetmaybedevotedtoadministrative functions such as controls, reports, and procedures. Many controls exist because management doesn’t trust employees. What if we could nix some of these controls and trust each other to do our best? It would be much less expensive and much more efficient.

Exploding the Trust Myth: “We Trust Each Other”Many organizations think that trust isn’t a concern.Onthesurfaceeverythingisfine,butoncloserinspectionyoumightdiscoverthatemployeesseektosatisfyonlytheirbasic,immediateneeds.Theirpassionislostinthedetailsofthejob,andovertime,workinginsuchanatmosphereprecipitateslethargy for some, and for others, illness.

Defining a Trusting WorkplaceWhen I speak to organizations about creatingtrustintheworkplace,thesearethemostcommonobservations participants shared about trustworthy companies and individuals:

“Shehasneverletmedown.”yy

“They do what they say they will do.”yy

“I know the organization has my best interests inyymind.”

“Heknowswhathe’stalkingaboutandadmitsityywhen he doesn’t.”

How to Build Trust Through InformationImagine your first day on the job in a neworganization.Asyouwalkinthedoor,younoticeroomsthatareoff-limitstoeveryonebutthemanager. Day after day, you see that information is carefully guarded and watched. Meetings occur behindcloseddoors.Managerswalkaround,andyousensetheyknowsomethingyoudon’t.Doesthissoundlikeafunandproductiveworkenvironment?

In these settings, employees guard information carefully. Information is often seen as intellectual propertyforboththeorganizationandforthosewho develop it. People put effort into creating informationandideasandstarttotakeownershipof them. In doing so, it becomes territorial and guarded. Pretty soon, a wedge develops between those who have access to information and

Creating a Trusting Environment in Your WorkplaceBy Jody Urquhart

Encourage your employees to share information, accept mistakes, and exchange ideas to learn and grow as a supportive, trusting team.

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those who don’t. Individuals who are excluded feel disconnected from the whole vision of theorganization,whichdiminishestrustandencourages people to further guard their ideas and limit their input.

Information bonds people to one another, an important part of positive growth and a sense ofcommunitywithinanorganization.Cuttingpeople off f rom access to information is unhealthy for progress, as information should be accessible to everyone.

Promotedepartment-widemeetings,encouragingemployees to share their information and ideas withtheteam.Createanaftermeetingfollow-upbulletin that discusses what was said. Much of the important information, however, will not be written. Instead, it comes in chance conversations, briefly mentioned in meetings, in the elevator, or in thelunchroom.Verifytheimportantinformationandmakeapointofdistributingittoemployees.

Keep employees well informed of what is going on, why it is happening, and how it affects their jobandtheorganizationasawhole.Explainthereason for any change, and how it will better serve management, employees, customers, suppliers, etc. Askforsuggestionsandinvolveeveryoneasmuchaspossible.Rememberthatemployeesaretheresourcethatmakesthingshappen,andthereforeitisessentialtogettheirbuy-in.

A Communication System to Make Information Accessible and Build TrustManaging information may be tricky. While youwanttokeeppeopleinformed,youdon’twanttooverwhelm them with information they don’t need toknow.Presentationisthekey.Hereisamethodto handle and communicate information:

Decide on the type of information and how you should disseminate it:

Organizationalphilosophyisanythingrelatedto1.thelong-termmission,vision,orthedirectionoftheorganization.Thisinformationisveryrelevant to all employees because it is the “glue”thatholdsdiversedepartmentsofanorganizationtogetherforasharedpurpose.However, it does not need to be presented at the year-endwheneveryoneisswampedwithwork.Savethisinformationandpresentthebiggerpicture on a monthly basis to help staff maintain focus.Youmayalsohaveanewsletterdevotedtoinitiativesthatsupporttheorganization’spurpose and vision.

Implement operations and procedures. If 2.information relates directly to an employee’s day-to-dayjob,thesoonersheknowsaboutit,the better. If information is important, you need a consistent system to disseminate it efficiently and effectively, possibly through staff meetings, individual coaching, bulletins, or announcements. Iftheinformationiscriticaltothejob,thenuseafeedbackorfollow-upproceduretoensureitis being incorporated. Develop a channel strictly for sharing critical information so that employees pay attention.

Avoidbroadcastingincompleteinformation.Very3.often managers will hear word of potentially nastythingslikemergersorlayoffsthatwouldaffect staff adversely, information that may be sensitive and still tentative. If you don’t have thefullinformation,youruntheriskofputtingpeopleonthedefensive.Sincetheydon’thaveallthepiecesofthecompletepuzzle,theyalsomayrush to false conclusions, which puts you in an awkwardsituation.Communicateinformationinauniform,consistentwaytopreventa“leak”of partial facts, rumors, and false conclusions. Refrainfromselectivelyputtingsomepeopleintheknowandnotothers.

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If you consistently organize and disseminateinformation through established means, then it is more readily understood. Employees will get used to getting updates about directives and will develop waystoutilizetheinformation.

Everyone Makes MistakesBe open when errors occur, avoiding punishingemployeesformakingmistakes.Whenpeople makemistakestheyusuallyfeelguiltyandtry tocoverup—anunfortunatereactionthatinhibitsthelearningprocess.Mistakesareapartofgrowth.Permit them to be shared so that others may alsolearnfromtheexample.Thiswillfoster an environment of openness that encourages creativity and autonomy. Celebrate solving mistakesasavictory.

Communicate: Why and HowWhen change occurs in an organization, employeesshould be included and involved. Change supports theorganization’smission,vision,andvalues,but by the time change affects your clients and staff, it ’s usually presented as tactics. In other words, management explains how change will occurandhowitwillaffectthejob,buttheyfailtoexplainthepurpose.The“why”embodiestheobjectiveandmeaningofanynewactivity.Onceemployeesunderstand“why,”the“how”oftenfallsmorereadilyintoplace.Openthelinesofcommunication. Employees should feel comfortable talkingopenlyandinformallyinasettingwhereeveryone’sopinionisgivenequalconsideration.

How to Encourage Criticism Without Losing ControlIn an open, trusting work environment that involvesand includes employee input, all feelings need to be heard—includingcriticism.Managementmustbeprepared to welcome and handle both positive and negativefeedback.

Createanopenworkspacewhereitissafetosupport one another. How can you accomplish this if employees are afraid to tell managers howtheyfeel?Supervisorscanencourageopendiscussion during individual coaching sessions.

Ask employees, “Is there anything that has beenbotheringyouthatyouwouldliketotalkabout?”Employeescananonymouslyofferfeedbacktoamanager’sweeklyreviewbox.Toprepareanofficeforusinga“feedbackbox,”stresstheneedforapositive tone and helpful remedies. Anonymous criticismcanbeacknowledgedinaquarterly“Critique”newsletter,includedasa“TalktoManagement”column.Theemployeeanonymouslyaddresses an issue, the newsletter publishes it and amanager’sresponse.Youmayalsoencourageinputinaregular“Let ’sTalk”focusgroup,whereemployees are invited to vent about anything they wantwiththeirco-workers.

Akeychallengeformanagementisrespondingto criticism of policies or procedures that affect employees but cannot be changed. It is important tohandlethesecritiquesinastraightforwardanddirect manner.

The Final SayWho gets the final say? Your employees do. Buildtrust in your office by involving employees and including their input, engaging them as part of thesolutiontoproblems.Thefoundationoftrustinanyorganizationisbuiltonaconcretebaseofopenness and input f rom others. l

Jody Urquhart is a professional speaker and author who compels stressed out and fed up professionals to rediscover their passion, purpose, and sense of play. This article reprinted with permission and is copyrighted by Jody Urquhart. To learn more, visit www.idoinspire.com.

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Book Review

If you’re anything like me, you’re constantly facedwiththetaskoffinding,training,anddevelopingyour team. We all search for strong, smart, motivated people to help us run our departments, seekingemployeeswhoworkhardwhileprovidingexcellentcustomerservice.Thisprocessstartsduring the interview and continues throughout the employer-employeerelationship.Continuallyweaskquestionsduringinterviewsorperformanceappraisals that evaluate an individual’s strengths andweaknesses.Amanagerfocusesondevelopingstrengths while expending a lot of energy to mitigatetheweaknessesofherself,herteam,andofthe departmental performance.

AccordingtoMarcusBuckinghamandDonaldClifton, Ph.D., authors of Now, Discover Your Strengths, we are wasting our time in trying overcomeweaknesses.TheauthorsarepartoftheGalluporganization,renownedfortheirpollingoperations, a wide array of management and human resources consulting services, and employee assessmenttools.Theauthorsdiscoveredthatmostorganizationsdon’tworkuptotheirpotentialbecause they are too focused on their employees’ weaknesses,failingtouseorfurtherdevelopthestaff ’s strengths and talents.

“Now, Discover Your Strengths”By Tony Lovett

Learn how to evaluate your own strengths and weaknesses, and those of your team, to achieve excellence as a business.

The book doesn’t stop at pointing out howbusinesses fail to assess, use, and sharpen employees’strengths.Theauthorsalsodevelopedaquestionnairethatdetermineswhatstrengthsweactually possess. I found this tool, as well as the contentofthebook,tobeextremelyinsightfulandinteresting.However,beware—Now, Discover Your Strengthsisaone-shotdeal.Iffamily,f riendsorco-workerswishtotakethequestionnaire,theonlywaypossibleisthroughpurchasinganotherbook,thepinnacleofmarketingatitsfinest.

Nevertheless, I highly encourage all Patient Access ManagerstotakeinCliftonandBuckingham’sinsights.Thefactis,weallunderstandourweaknesses,butwemaynotknowstrengthsandpotentialasprofessionals.Thiscouldbeasbiganeye opener for you and your staff as it was for me. l

Tony Lovett, MBA, CHAM, has worked in the healthcare industry for 14 years. Currently he serves as Patient Access Director at Cypress Fairbanks Medical Center, a part of the Tenet Healthcare family of hospitals in the Houston, Texas area. Tenet Healthcare operates 15,894 beds within 63 acute care hospitals in 12 states.

NAHAM’S Guide to Up-Front Collections is a compilation of findings and resources gathered from both the NAHAM Up-Front Collections Collaborative, a comprehensive, year-long study that documented the collections efforts of a diverse group of hospitals from across the country, and the input of over 50 members actively engaged in up-front collections.

We have compiled an easy-to-use CD-ROM and outlined a flexible, do-it-yourself approach to developing, improving and maintaining cash collections procedures in Patient Access.

To order your copy visit www.naham.org to conveniently order online. Take action today to begin to improve the collections outcomes at your hospital

ARE YOUR COLLECTIONS EFFORTS ALL WORK AND NO “PAY”?

Access departments can successfully implement and maintain up-front collections practices that work.

National Association ofHealthcare Access Management

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May 27–30, 2009 | Mandalay Bay Resort & Casino | Las Vegas, Nevada

Place Your Bets on Patient Access Services

NAHAM 35th Annual National Conference and Exposition

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